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Flashcards in Liver Path II Deck (53):
1

centrilobular

zone 3

necrosis - with right heart failure

2

periportal

zone 1

necrosis with phosphorus, eclampsia, mushroom toxicity

3

fulminant masive necrosis of liver

usually fatal

amanita mushroom

4

bridging fibrosis

portal to portal

seen with trichrome stain

5

fulminant liver failure

acute liver failure

acute liver illness with enceophalopathy and coagulopathy within 26 weeks of initial liver injury

massive hepatocyte necrosis >80%

acetaminophen toxicity, drug rxns, toxins, viruses

ICU and liver transplant

6

chronic liver failure

loss of 80-90% liver function

jaundice, edema, forgetful (hyperammonia)

fetor hepatis - smelly breath

parotid gland enlargement

PT time - factor VII

7

hepatic encephalopathy

hyper ammonia

8

PT time

increased bc of factor VII decrease in chronic liver failure

9

nodules of liver

can be palpable

10

12th leading cause of death

cirrhosis

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cirrhosis characteristics

bridging fibrosis
parenchymal nodules
disruption of enter liver - diffuse

12

nodularity of cirrhosis

from regeneration of hepatocytes

13

cirrhosis

irreversible
-rarely - regression can occur

but do still have risk of hepatocellular carcinoma

14

diagnosis of cirrhosis

see regenerating hepatocytes

15

etiology of cirrhosis

hep C - alcohol - cryptogenic

16

stellate cells

to myofibroblasts - by PDGFR and TNF
-induce ECM deposition and cirrhosis**

kupffer cells - cytokines stimulate fibrogenesis in stellate cells

collagen in space of disse

17

biliary channels

rate limiting step in bilirubin excretion - lost in cirrhosis

18

anorexia, weight loss, fatigue, weakness

cirrhosis

19

PDGF and TNF

activate stellate cells

20

endothelin 1

stimulate contraction of stellate cells

21

TGF-beta

stimulate fibrogenesis

22

canonical principle

necrosis of hepatocytes
to myofibroblasts


leads to liver fibrosis

23

NO

vascular relaxation and stellate cell apoptosis

24

angiogenesis in cirrhosis

increased sinusoid vessls with cirrhosis
-micro and macronodules form

could theoretically serve as portal pressure reducing shunts

25

acute liver injury

apoptosis of hepatocytes

minor - can regenerate

major - loss of hepatocytes

canals of hering - liver progeneritor cells

genesis signaling - hedgehog, Wnt, hedgehog

26

portal HTN

with fibrosis and sinusoid remodeling

also low NO, increased vasoconstrictors, and endothelial dysfunction

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micronodular

less than 3mm

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macronodular

greater than 3mm

29

nodules

regenerating hepatocytes

30

bridging fibrosis

connect portal triads and centrilobular hepatocytes
-create islands of regeneration

31

liver cords two cells thick

presumptive of regeneration

32

portal HTN

increase portal venous pressure 8-10mmHg or hepatic vein/portal vein gradient >5mmHg

see collaterals open - esophageal varices, hemorrhoids, caput medusa

33

portal HTN path

2/3 structural - sinusoid resistance

1/3 dynamic - increased portal venous flow
-uncleared got bacteria - produce NO

34

result of portal HTN

ascites
portosystemic shunts
congestive splenomegaly
hepatic encephalopathy

35

pre-hepatic portal HTN

portal or splenic vein occlusion

36

intra-hepatic portal HTN

pre-sinusoid - schistosomiasis, sarcoidosis
sinusoidal - cirrhosis, alcoholi hepatitis
post-sinusoid - veno-occlusive disease, pyyrolizidine

37

pyrollizidine

ca lead to post-sinusoid intrahepatic portal HTN

38

post -hepatic portal HTN

right side HF
constrictive pericarditis
hepatic vein outflow obstruction - budd chiari - 2 veins needed**

39

most common cause of portal HTN

cirrhosis

40

falciform ligament with abdominal wall collaterals

caput medusa

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most problematic shunt

esophageal varices

42

esophageal and azygous veins

esophageal varices

43

between superior rectal vein and lower rectal veins

hemorrhoids

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between paraumbilical veins and abdominal epigastric veins

caput medusa

45

between colic veins and retroperitoneal veins

portosystemic shunt

46

splenomegaly

can occur in splenomegaly
-hypersplenism

leads to pancytopenia

47

gamna gandy bodies

microscopic foci of fibrotic iron laden nodules in splenic parenchyma

-with splenomegaly due to portal HTN

48

ascites

excess fluid in abdomen

commonly due to cirrhosis

49

path of ascites

sinusoid HTN

sodium and water retention

vasodilation of splanchnic circulation - RAAS system - increased ADH

50

peritoneal ascites

carcinoma - tuberculosis

see high protein

51

non-peritoneal ascites

cirrhosis and heart failure

see low protein (but albumin still in ascitic fluid

52

spontaneous bacterial peritonitis

ascites pt with fever, abdominal pain

E. coli and s. pneumonia

53

hydrothorax

more common on right - right pleural effusion

can occur with ascites